Purpose@#The benefit of
adjuvant chemotherapy following curative-
intent surgery in pancreatic ductal
adenocarcinoma (PDAC)
patients who had received neoadjuvant FOLFIRINOX is unclear. This study aimed to assess the
survival benefit of
adjuvant chemotherapy in this
patient population . @*Materials and
Methods @#This
retrospective study included 218
patients with localized non-metastatic PDAC
who received neoadjuvant FOLFIRINOX and underwent curative-
intent surgery (R0 or R1) between January 2017 and December 2020. The
association of
adjuvant chemotherapy with
disease-free survival (DFS) and overall
survival (OS) was evaluated in overall
patients and in the
propensity score matched (PSM) cohort. Subgroup
analysis was conducted according to the
pathology -proven
lymph node status. @*Results@#
Adjuvant chemotherapy was administered to 149
patients (68.3%). In the overall cohort, the
adjuvant chemotherapy group had significantly improved DFS and OS compared to the
observation group (DFS median, 13.8 months [95%
confidence interval (CI), 11.0 to 19.1] vs. 8.2 months [95% CI, 6.5 to 12.0]; p < 0.001; and OS median, 38.0 months [95% CI, 32.2 to not assessable] vs. 25.7 months [95% CI, 18.3 to not assessable]; p=0.005). In the PSM cohort of 57 matched pairs of
patients , DFS and OS were better in the
adjuvant chemotherapy group than in the
observation group (p < 0.001 and p=0.038, respectively). In the
multivariate analysis ,
adjuvant chemotherapy was a significant favorable
prognostic factor (vs.
observation ; DFS
hazard ratio [HR], 0.51 [95% CI, 0.36 to 0.71; p < 0.001]; OS HR, 0.45 [95% CI, 0.29 to 0.71; p < 0.001]). @*Conclusion@#Among PDAC
patients who underwent
surgery following neoadjuvant FOLFIRINOX,
adjuvant chemotherapy may be associated with improved
survival . Randomized studies should be conducted to validate this finding.